Thursday, August 23, 2007

This fall, United HealthCare is coming out with some new group plans (yippee). One of the interesting "twists" is that the co-insurance reimbursement rate (the "80" in "80/20") will be substantially lower for patients/insureds who choose not to go to a "designated provider." That is, it's not enough that your doc is "in the network;" he must be "designated" ("super qualified," whatever) in order for you to receive the best level of benefits.

UHC's new program isn't unique, but these programs raise some interesting questions. Perhaps the most curious would be "okay, that's nice, but what about the other doc's, the ones who didn't make the cut?" Not that this is anything new: a few months ago, we reported on the case of Dr Michael Kelly, who was unceremoniously dumped by both Blue Cross and United. Well, not "dumped," per se, but no longer designated as a "high quality doctor." The tip of an iceberg, perhaps?

Well, you may not be surprised to learn that physicians like Dr Kelly are not happy campers. Over at Managed Care Matters, our friend (and sometimes foil) Joe Paduda reports on the steps these "also rans" are taking to regain their good names (and cash flow). And as is usual at MCM, the resulting comments are every bit as interesting as the post itself.

This fall, United HealthCare is coming out with some new group plans (yippee). One of the interesting "twists" is that the co-insurance reimbursement rate (the "80" in "80/20") will be substantially lower for patients/insureds who choose not to go to a "designated provider." That is, it's not enough that your doc is "in the network;" he must be "designated" ("super qualified," whatever) in order for you to receive the best level of benefits.

UHC's new program isn't unique, but these programs raise some interesting questions. Perhaps the most curious would be "okay, that's nice, but what about the other doc's, the ones who didn't make the cut?" Not that this is anything new: a few months ago, we reported on the case of Dr Michael Kelly, who was unceremoniously dumped by both Blue Cross and United. Well, not "dumped," per se, but no longer designated as a "high quality doctor." The tip of an iceberg, perhaps?

Well, you may not be surprised to learn that physicians like Dr Kelly are not happy campers. Over at Managed Care Matters, our friend (and sometimes foil) Joe Paduda reports on the steps these "also rans" are taking to regain their good names (and cash flow). And as is usual at MCM, the resulting comments are every bit as interesting as the post itself.